These two measures are measuring inpatient encounters that were preceded by an emergency department visit that completed within an hour before the inpatient encounter began. It is possible that CCN 2 is reporting the measure even though the duration in the ED and the duration to admit decision reflects the care process at a different CCN where the ED visit actually occurred (CCN 1).

After the helpful input from the CRP, the final recommendations are: 1. Measure Populations, Exclusions, and Observations a. Measure Population: i. ED-1(CMS55) and ED-2(CMS111): Use new timing to account for possible gap in Observation Status ii. ED-3(CMS32): Remove exclusion for ED Visits that are not part of a larger “episode of care” and move to measure exclusion b. Measure Exclusion i. ED-1(CMS55) and ED-2(CMS111): Add exclusion for ED Visits transferred from another hospital setting ii. ED-3(CMS32): Add exclusion for ED Visits that are part of a larger episode of care.” c. Measure Observation i. ED-1 (CMS55) and ED-2 (CMS111): Use Facility Location Arrival Datetime ii. ED-1 (CMS55): Use Facility Location Departure Datetime with clarified definition iii. ED-3 (CMS32): No Change. 2. Stratification a. ED-2(CMS55) and ED-2(CMS111): i. Stratum 1: Primary Diagnosis is a Mental Health Disorder ii. Stratum 2: Primary Diagnosis is NOT a Mental Health Disorder b. ED-3(CMS32): i. Stratum 1: Primary Diagnosis is a Mental Health Disorder ii. Stratum 2: Transferred to an Acute Care or VA hospital within 6 hours of the end of the ED visit iii. Stratum 3: Primary Diagnosis is NOT a Mental Health Disorder AND NOT transferred to an Acute Care or VA hospital within 6 hours of the end of the ED visit iv. Stratum 4: Primary Diagnosis is a Mental Health Disorder AND transferred to an Acute Care or VA hospital within 6 hours of the end of the ED visit